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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------- ------ Permit No. (Complete in Triplicate) G- ------------- Date Issued -------------------- _ - --------- This This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is madein comp ' nc ith County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LO TIONNS- - __ -±------ ----------- CENSUS TRACT ��- `z----- -------- -- - - ''"--------P e --------- Owner's,Name, _______ Address -----�rl�f/ - -- --- -- --------�� - ------- --------------- City r Contractor's Name -- -------_- --�� --c,-- --- --"License # ,�� 3- _ Phon ----------------------------- Installation will serve: Residence)]Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------- Number of living units:----1_------ Number of bedrooms 4----__Garbage Grinder ------------ Lot Size - _ _______-___._--------------------- Water Supply: Public System and name ---------------------------------•------------------------------------------------------- -----------------Private [ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ,0 Clay Loam ❑ Hardpan ❑ Adobe t Fill Material ------------ If yes,type -----------r________-____ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (^ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK' Sizeb-�� 9� s/-------------------- Liquid Depth _ ___________________ Capacity -� ®-0 Type Material__ ` ,G No.. Compartments '�------- ---•--- � Distance to nea st: Well ......... s/___�Q.________- Prop. Line ___�_�______________ f LEACHING LINE (X] No. of Lines ------ ------------ Length of each line----- ---------------- Total Length _/S�_________ ________ 'D' Box .44j_ Type Filter Material ----�•_R-D-_____Depth Filter Material ---I�--_________....................... Distance nearest: Well ._"__�`�..__________ Foundation -------- -__ Property Line _S__0______________ SEEPAGE PIT' [y] Depth ___-c??-5-----.- Diameter ----4V------ Number ------ ______________ Rock Filled Yes No � Water Table Depth ------------------------------------------------Rock Size // ,"-/3-a--------------- Distance to nearest: Well -----------1bO---------_---------Foundation -----/_,?--------- Prop. Line _-�................ REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date ----------------------------------) Septic Tank (Specify Requirements) ------------------------------------------------------ -------- ---------------------------------------------- Disposal Field (Specify Requirements) _____-______ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------=---------------------------------------------------------------------------------------------------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------ Owner _ ---- ------- - -------- ---------------------------- BY ------------- ---- ----------------------- Title _l --- ----------------- ---------------------------- (If other than owner FOR DEPARTMENT USE ONLY ..APPLICATION ACCEPTED BY -------- 06/1 ------------------------------------------------ DATE ------ --- 6__-AA'770- -------- BUILDING PERMIT ISSUED ------ --------- t--- - ---- -----DATE ---- La, (TION CO MENT "�K & P i11� � - - � �- - -E--R- .-A ------------------------------------ ------------------------------- ---- - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------=------- ---------------------------- ----- Final Inspection by: _-_ s Date ----------- _. _____ ----- ---- - --- --------------------------,�--J5_ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M